20040191.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF -BUSINESS I
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP I TELEPHONE
USE
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ADDRESS
PLAT NAME/SUBDIVISION NO.
I PERMIT EXPIRES
PERMIT
'2 1 /
NUMBER 10)LI-01L
LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE S
TESCP Approved
RW Pernia Required
Street Use permit Rect'd
inspection Required
sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 0 NO E3
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR E20SION CONTROLIDRAINAGE
NAME CBL 4 1
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ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT
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00903
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
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FENCE
( X FT)
DEMOLISH
TANK
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OTHER
GARAGE
RETAINING WALL
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FIRE SPRINKLER
CARPORT
ROOKERY
FIRE ALARM
(TYPE OF USE, BUSINE§§ OR ACTIVITY) EXPLAIN
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W NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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0 STOR 50:4 UNITEL NUMBER
IES <:::---- I I
DESCRIBE WORK TO BE DONE
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THIS PERMIT AUTHORIZES ONILY THE WORK NOTED ' THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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11) IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHAT EVER NATURE, ARISING DIRECTLYOR INDIRECILY
X1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAI L NOT BE
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_j DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEUGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I ANLZ HE OWNER OR THE DULY AUTHORIZED AGENTOF
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THE OWNER. I AGR�E TO -COMPLY/ � I CITY AN6 STATE LAWS REGULATING CONSTRUC-
TION;_A�D IN DOIN TH 'W,ORK A'UTIII)RIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIO T BOR �UOR F THE STATE OF WASHINGTON RELATING TO
Z' R K MA2 �1'10 A I N ANCE AND RCW 10.27.
IGIRE MNE FAI T.ENT-) DATEGNED
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FIRE REVIEWED BY DATE UJI
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VARIANCE OR CU SHORELINE OR ADEI# I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I —
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
CHECKED BY I TYPE OF qO
,tISTRUCTION CODE OCCUPANT
?77 GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review PlanChk.Deposit
Fire Inspection Receipt #
LandscapeInsp. Total Amt. Due
�3
Recording Fee Receipt #
APPLICATION APPROVAL
This application is riot a permit until signed by the
CALL building Official or hisihor Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
(425) OFFICIALS SIGNATURE D TE
771-0220 'RE LEA D '55 0
DATE
ATTkNTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINA/L -ILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK- NER GOLD -ASSESSOR
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ALL NEW, EXTENDED, RE -BUILT OR
RELOCATED ELECTRICAL UTILITY AND/OR
SERVICE SHALL BE PLACED UNDERGROUND z
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RECEIVED
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FEB 2 5 2004
CITY COPY PERMIT COUNTER
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
all Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. I v N,�% r5
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